Pharmacy Utilization Management Specialist - Hybrid - Newark, NJ - Contract

Walker Healthforce, Inc.; Newark (NJ); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Competitive pay

Direct deposit

Medical, dental & vision

401k

Job summary

Walker Healthforce, Inc. in Newark, NJ is seeking a Pharmacy Utilization Management Specialist for a hybrid, contract role starting ASAP. This position offers 40 hours weekly with a W2 worker arrangement.

You will manage prior authorizations, assist members and providers with eligibility and claims issues, support formulary adherence, handle appeals, and contribute to ad-hoc reporting and program operations.

Qualifications

• 2+ years of third-party prescription program claim adjudication experience.
• 2+ years of Pharmacy Utilization Management Specialist experience.
• Prior customer service or service quality initiative experience.
• Experience with prior authorizations, pharmacy claims, coverage determinations, and medical criteria.
• Bachelor's degree in Health Care Management, Business, Pharmaceutical Administration, or related field (bonus).

Responsibilities

• Process prior authorization requests and evaluate medical necessity according to established criteria.
• Support members, physician offices, pharmacies, and internal stakeholders with eligibility, coverage, and claims issues.
• Assist with formulary compliance and generic dispensing initiatives.
• Process appeals, complaints, inquiries, and compliance-related issues.
• Support ad-hoc reporting and information requests; assist with Pharmacy department operations.
• Participate in training related to pharmacy services programs and operations.

Skills

Third-party prescription program claim

Pharmacy Utilization Management

Customer service / service quality

Prior authorizations & claims handling

Education

Bachelor's degree in Health Care Management, Business, Pharmaceutical Administration, or related field

Job description

Pharmacy Utilization Management Specialist | Hybrid | Newark, NJ | Contract

Start Date: ASAP

Location: Hybrid - Newark, NJ

Hours/Schedule: Monday-Friday, 40 hours

Worker Type: W2

Core Requirements:

• 2+ years of third-party prescription program claim adjudication experience
• 2+ years of Pharmacy Utilization Management Specialist experience
• Prior customer service/service quality initiative experience
• Experience with prior authorizations, pharmacy claims, coverage determinations, and medical criteria

We Consider It A Bonus If You Also Have:

• Bachelor's degree in Health Care Management, Business, Pharmaceutical Administration, or a related field

Job Responsibilities:

• Process prior authorization requests and evaluate medical necessity and appropriateness based on established criteria
• Support members, physician offices, pharmacies, and internal stakeholders with eligibility, coverage, and claims issues
• Assist with formulary compliance and generic dispensing initiatives
• Process appeals, complaints, inquiries, and compliance-related issues
• Support ad-hoc reporting and information requestsAssist with pharmacy department operations, Medication Therapy Management, and clinical pharmacy programs
• Participate in training related to pharmacy services programs and operations

What We Offer:

• Competitive compensation package
• Weekly pay via Direct Deposit
• Medical, Dental & Vision available
• 401k options

Why Work With Walker?

• Access to our top ranked team of recruiting and placement specialists
• Continuous, one-on-one support from a dedicated engagement manager
• Professional resume development and interview preparation

About Us:

Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we're custom not commodity and we've been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!

We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment.